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P422 Risks and clinical features of active tuberculosis developed in patients with inflammatory bowel disease receiving anti-tumour necrosis factor therapy

J. W. Lee, C. H. Choi*

Chung-Ang University College of Medicine, Internal Medicine, Seoul, South Korea

Background

Anti-tumour necrosis factor-α (TNFα) antibodies are widely used for the treatments of active ulcerative colitis (UC) and Crohn’s disease (CD). However, anti-TNF therapy is associated with increased risks of infections including tuberculosis (TB). TB infection is an important concern in Korea where the prevalence of latent and active TB is still high. We analysed the clinical features of Korean patients with inflammatory bowel disease (IBD) who have had active TB during anti-TNF therapy.

Methods

Active TB cases developed in patients with IBD during anti-TNF therapy from January 2007 to December 2014 were collected from 15 academic hospitals in Korea. Further, 26 cases of active TB in patients treated with infliximab (n = 23) or adalimumab (n = 2) or both (n = 1) for UC (n = 4) or CD (n = 22) were reviewed retrospectively. We analysed demographics, the interval between the start of anti-TNF therapy and active TB development, screening tests for latent TB infection (LTBI), immunosuppressive drug use, and the details of the diagnosis and treatments of TB.

Results

The prevalence of active TB was approximately 2.2% in IBD patients with infliximab (n = 23) and 0.7% with adalimumab (n = 3), respectively. The median time to the development of active TB after the initiation of anti-TNF therapy was 5 months (range: 2–45). In addition, 3 patients had past histories of treatment for active TB. A tuberculin skin test (TST) and/or interferon gamma releasing assay (IGRA) were performed in 22 patients (84.6%) to screen for LTBI before anti-TNF treatment. Moreover, 16 patients were examined using TST, 14 patients using IGRA, and 8 patients using both. Positive findings in a tuberculosis skin test (TST) and/or IGRA were observed in 3 patients, who received anti-TB prophylaxis. Seven patients reacted negatively in both TST and IGRA and were normal on their chest X-ray. The most common site of active TB was the lung (n = 21, 81%). The active TB was cured in 24 patients, but 2 patients died from TB progression.

Conclusion

Active TB can develop during anti-TNF therapy in IBD patients without LTBI, and even in patients who had past histories of treatment for TB or LTBI prophylaxis. Physicians should pay attention to TB development during anti-TNF therapy, especially in countries with a high prevalence of TB.